A case series of percutaneous tension band wiring technique for fixation of fractures of olecranon and patella

There are several advantages in the treatment of fractures by means of closed reduction. Percutaneous fixation is a type of biological fixation. The aim and objectives of this study are to demonstrate the technique of percutaneous tension band wiring in cases of transverse, non- comminuted olecranon and patella fractures and to decrease the soft tissue dissection, blood loss, chances of infection and to ensure speedy mobilization using the innovative percutaneous fixation technique. This retrospective study includes ten patients of olecranon and ten patients of patella operated by the same surgeon. All patients were operated with percutaneous tension band wiring for olecranon and patella. There were six males and four females with olecranon fractures. There were seven males and three females who suffered patella fractures. The average duration of surgery was 55 minutes and average follow up was 24±6 weeks. The suture removal was done at 2 weeks. All patients had full range of movements at six weeks with significantly improved DASH score and Oxford knee score. None of the patients had any complications. Percutaneous fixation decreases the chances of bleeding secondary to unnecessary soft tissue dissection, thereby decreasing the post-operative morbidity. It also, convincingly, decreases the chances of post-operative infection and promotes early mobilization. Closed reduction with percutaneous fixation is believed to be an innovative, safe, reliable and efficient method of managing these difficult fractures

Potential Influence of Advance Care Planning and Palliative Care Consultation on ICU Costs for Patients With Chronic and Serious Illness.

OBJECTIVES: To estimate the potential ICU-related cost savings if in-hospital advance care planning and ICU-based palliative care consultation became standard of care for patients with chronic and serious illness. DESIGN AND SETTING: Decision analysis using literature estimates and inpatient administrative data from Premier. PATIENTS: Patients with chronic, life-limiting illness admitted to a hospital within the Premier network. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using Premier data (2008-2012), ICU resource utilization and costs were tracked over a 1-year time horizon for 2,097,563 patients with chronic life-limiting illness. Using a Markov microsimulation model, we explored the potential cost savings from the hospital system perspective under a variety of scenarios by varying the interventions\u27 efficacies and availabilities. Of 2,097,563 patients, 657,825 (31%) used the ICU during the 1-year time horizon; mean ICU spending per patient was 11.3k (SD, 17.6k). In the base-case analysis, if in-hospital advance care planning and ICU-based palliative care consultation were systematically provided, we estimated a mean reduction in ICU costs of 2.8k (SD, 14.5k) per patient and an ICU cost saving of 25%. Among the simulated patients who used the ICU, the receipt of both interventions could have resulted in ICU cost savings of 1.9 billion, representing a 6% reduction in total hospital costs for these patients. CONCLUSIONS: In-hospital advance care planning and palliative care consultation have the potential to result in significant cost savings. Studies are needed to confirm these findings, but our results provide guidance for hospitals and policymakers

Evaluating the Economic Impact of Palliative and End-of-Life Care Interventions on Intensive Care Unit Utilization and Costs from the Hospital and Healthcare System Perspective.

Purpose of report: Understanding the impact of palliative care interventions on intensive care unit (ICU) costs and utilization is critical for demonstrating the value of palliative care. Performing these economic assessments, however, can be challenging. The purpose of this special report is to highlight and discuss important considerations when assessing ICU utilization and costs from the hospital perspective, with the goal of providing recommendations on methods to consider for future analyses. FINDINGS: ICU length of stay (LOS) and associated costs of care are common and important outcome measures, but must be analyzed properly to yield valid conclusions. There is significant variation in costs by day of stay in the ICU with only modest differences between an ICU day at the end of a stay and the first day on the acute care floor; this variation must be appropriately accounted for analytically. Furthermore, reporting direct variable costs, in addition to total ICU costs, is needed to understand short-term and long-term impact of a reduction in LOS. Importantly, incentives for the hospital to realize savings vary depending on reimbursement policies. SUMMARY: ICU utilization and costs are common outcomes in studies evaluating palliative care interventions. Accurate estimation and interpretation are key to understanding the economic implications of palliative care interventions

Transport methods and interactions for space radiations

A review of the program in space radiation protection at the Langley Research Center is given. The relevant Boltzmann equations are given with a discussion of approximation procedures for space applications. The interaction coefficients are related to solution of the many-body Schroedinger equation with nuclear and electromagnetic forces. Various solution techniques are discussed to obtain relevant interaction cross sections with extensive comparison with experiments. Solution techniques for the Boltzmann equations are discussed in detail. Transport computer code validation is discussed through analytical benchmarking, comparison with other codes, comparison with laboratory experiments and measurements in space. Applications to lunar and Mars missions are discussed

Estimating the Effect of Palliative Care Interventions and Advance Care Planning on ICU Utilization: A Systematic Review

OBJECTIVE: We conducted a systematic review to answer three questions: 1) Do advance care planning and palliative care interventions lead to a reduction in ICU admissions for adult patients with life-limiting illnesses? 2) Do these interventions reduce ICU length of stay? and 3) Is it possible to provide estimates of the magnitude of these effects? DATA SOURCES: We searched MEDLINE, EMBASE, Cochrane Controlled Clinical Trials, and Cumulative Index to Nursing and Allied Health Literature databases from 1995 through March 2014. STUDY SELECTION: We included studies that reported controlled trials (randomized and nonrandomized) assessing the impact of advance care planning and both primary and specialty palliative care interventions on ICU admissions and ICU length of stay for critically ill adult patients. DATA EXTRACTION: Nine randomized controlled trials and 13 nonrandomized controlled trials were selected from 216 references. DATA SYNTHESIS: Nineteen of these studies were used to provide estimates of the magnitude of effect of palliative care interventions and advance care planning on ICU admission and length of stay. Three studies reporting on ICU admissions suggest that advance care planning interventions reduce the relative risk of ICU admission for patients at high risk of death by 37% (SD, 23%). For trials evaluating palliative care interventions in the ICU setting, we found a 26% (SD, 23%) relative risk reduction in length of stay with these interventions. CONCLUSIONS: Despite wide variation in study type and quality, patients who received advance care planning or palliative care interventions consistently showed a pattern toward decreased ICU admissions and reduced ICU length of stay. Although SDs are wide and study quality varied, the magnitude of the effect is possible to estimate and provides a basis for modeling impact on healthcare costs

Cytotoxic Effect of Poly-Dispersed Single Walled Carbon Nanotubes on Erythrocytes In Vitro and In Vivo

Single wall Carbon Nanotubes (SWCNTs) are hydrophobic and do not disperse in aqueous solvents. Acid functionalization of SWCNTs results in attachment of carboxy and sulfonate groups to carbon atoms and the resulting acid functionalized product (AF-SWCNTs) is negatively charged and disperses easily in water and buffers. In the present study, effect of AF-SWCNTs on blood erythrocytes was examined. Incubation of mouse erythrocytes with AF-SWCNTs and not with control SWCNTs, resulted in a dose and time dependent lysis of erythrocyte. Using fluorescence tagged AF-SWCNTs, binding of AF-SWCNTs with erythrocytes could be demonstrated. Confocal microscopy results indicated that AF-SWCNTs could enter the erythrocytes. Treatment with AF-SWCNTs resulted in exposure of hydrophobic patches on erythrocyte membrane that is indicative of membrane damage. A time and dose dependent increase in externalization of phosphatidylserine on erythrocyte membrane bilayer was also found. Administration of AF-SWCNTs through intravenous route resulted in a transient anemia as seen by a sharp decline in blood erythrocyte count accompanied with a significant drop in blood haemoglobin level. Administration of AF-SWCNTs through intratracheal administration also showed significant decline in RBC count while administration through other routes (gavage and intra-peritoneal) was not effective. By using a recently developed technique of a two step in vivo biotinylation of erythrocytes that enables simultaneous enumeration of young (age <10 days) and old (age>40 days) erythrocytes in mouse blood, it was found that the in vivo toxic effect of AF-SWCNTs was more pronounced on older subpopulation of erythrocytes. Subpopulation of old erythrocytes fell after treatment with AF-SWCNTs but recovered by third day after the intravenous administration of AF-SWCNTs. Taken together our results indicate that treatment with AF-SWCNTs results in acute membrane damage and eventual lysis of erythrocytes. Intravenous administration of AF-SWCNTs resulted in a transient anemia in which older erythrocytes are preferably lysed

Spectroscopic Evidence for the Localization of Skyrmions near Nu=1 as T->0

Optically pumped nuclear magnetic resonance measurements of Ga-71 spectra were carried out in an n-doped GaAs/Al0.1Ga0.9As multiple quantum well sample near the integer quantum Hall ground state Nu=1. As the temperature is lowered (down to T~0.3 K), a ``tilted plateau'' emerges in the Knight shift data, which is a novel experimental signature of quasiparticle localization. The dependence of the spectra on both T and Nu suggests that the localization is a collective process. The frozen limit spectra appear to rule out a 2D lattice of conventional skyrmions.Comment: 4 pages (REVTEX), 5 eps figures embedded in text, published versio

Toolbox for Discovering Dynamic System Relations via TAG Guided Genetic Programming

Data-driven modeling of nonlinear dynamical systems often require an expert user to take critical decisions a priori to the identification procedure. Recently an automated strategy for data driven modeling of \textit{single-input single-output} (SISO) nonlinear dynamical systems based on \textit{Genetic Programming} (GP) and \textit{Tree Adjoining Grammars} (TAG) has been introduced. The current paper extends these latest findings by proposing a \textit{multi-input multi-output} (MIMO) TAG modeling framework for polynomial NARMAX models. Moreover we introduce a TAG identification toolbox in Matlab that provides implementation of the proposed methodology to solve multi-input multi-output identification problems under NARMAX noise assumption. The capabilities of the toolbox and the modelling methodology are demonstrated in the identification of two SISO and one MIMO nonlinear dynamical benchmark models

BWIBots: A platform for bridging the gap between AI and human–robot interaction research

Recent progress in both AI and robotics have enabled the development of general purpose robot platforms that are capable of executing a wide variety of complex, temporally extended service tasks in open environments. This article introduces a novel, custom-designed multi-robot platform for research on AI, robotics, and especially human–robot interaction for service robots. Called BWIBots, the robots were designed as a part of the Building-Wide Intelligence (BWI) project at the University of Texas at Austin. The article begins with a description of, and justification for, the hardware and software design decisions underlying the BWIBots, with the aim of informing the design of such platforms in the future. It then proceeds to present an overview of various research contributions that have enabled the BWIBots to better (a) execute action sequences to complete user requests, (b) efficiently ask questions to resolve user requests, (c) understand human commands given in natural language, and (d) understand human intention from afar. The article concludes with a look forward towards future research opportunities and applications enabled by the BWIBot platform